FTFA: Tracheotomies are typically used to open an air passage directly to the windpipe for patients who can't breathe otherwise.

Tracheotomies are common in patients who cannot be weened from the ventilator, or who will require long-term intubation and airway support. Not trying to argue with what the article says, but that's rather misleading of a statement.

FTFA:Based in part on surreptitious tape recordings, an FBI affidavit lays out allegations that a Sacred Heart pulmonologist kept patients too sedated to breathe on their own, then ordered unneeded tracheotomies for them -- enabling the for-profit hospital to reap revenue of as much as $160,000 per case.

You've got to be farking kidding me.

FTFA: : The physician could bill $160 each time he visited a tracheotomy patient at the hospital, versus $32 for seeing a ventilator patient in a nursing home.

I moved up here to Canada recently, and I've had to explain this numerous times. It's just easier to say, "The US Government is a wholly owned subsidiary of big business, including the medical industry. The entire function of the populace is to produce profit, which is then used to bribe lawmakers. Yeah, we know it sucks, but no one there is willing to up their taxes by a red cent to pay for health care or other entitlements, so this is how it is. Also, Americans are farking crazy."

And this is exactly why whenever I have to be hospitalized, I ensure that an intelligent family member or friend is present who can speak with the medical staff when I'm not able to. Yes, it might annoy the medical staff ("I have a degree and this person is challenging me?!") but it also ensures that I'm not receiving unnecessary care purely for billing purposes.

hardinparamedic:FTFA: Tracheotomies are typically used to open an air passage directly to the windpipe for patients who can't breathe otherwise.

Tracheotomies are common in patients who cannot be weened from the ventilator, or who will require long-term intubation and airway support. Not trying to argue with what the article says, but that's rather misleading of a statement.

FTFA: Based in part on surreptitious tape recordings, an FBI affidavit lays out allegations that a Sacred Heart pulmonologist kept patients too sedated to breathe on their own, then ordered unneeded tracheotomies for them -- enabling the for-profit hospital to reap revenue of as much as $160,000 per case.

You've got to be farking kidding me.

FTFA: : The physician could bill $160 each time he visited a tracheotomy patient at the hospital, versus $32 for seeing a ventilator patient in a nursing home.

Which is Medicare in a nutshell.

The infection risk for tracheotomies is higher, so they probably want to incentivize them being checked regularly.

But yeah, there are some weird Medicare reimbursements that really skew what doctors are willing to do. If the best procedure for a condition just barely brings in enough money to cover OR costs and staff, so the surgeon has to donate their time, no one is going to build a practice doing that.

From TFA: Almost all its customers are Medicare or Medicaid recipients, according to state and federal reports.

Sacred Heart is probably considered a disproportionate share hospital (DSH) because of its clientele and thus would receive more in Medicare/Medicaid payments. I'd love to know what this hospital's case mix index is.

FTFA: Based in part on surreptitious tape recordings, an FBI affidavit lays out allegations that a Sacred Heart pulmonologist kept patients too sedated to breathe on their own, then ordered unneeded tracheotomies for them -- enabling the for-profit hospital to reap revenue of as much as $160,000 per case.

The worst thing is the fact that hospitals get paid more for making mistakes than they do for doing the job right. Any complications from surgery earn the hospital more than 3x what the surgery itself can be billed for. So there is a huge incentive to have to do repeat surgeries to fix "mistakes".

My google-fu is failing me. Why is it called Sacred Heart if it's owned by a private corporation, not the Catholic Church? Did it used to be a Catholic outfit until Scrooge McDuck bought it, and they didn't bother to rename it Grand Nagus Zek Memorial Hospital? Did the owners give it a Catholicy name so the rubes would think it was Catholic? Any Chicagoan farkers know what the deal is here?

Skirl Hutsenreiter:hardinparamedic: FTFA: Tracheotomies are typically used to open an air passage directly to the windpipe for patients who can't breathe otherwise.

Tracheotomies are common in patients who cannot be weened from the ventilator, or who will require long-term intubation and airway support. Not trying to argue with what the article says, but that's rather misleading of a statement.

FTFA: Based in part on surreptitious tape recordings, an FBI affidavit lays out allegations that a Sacred Heart pulmonologist kept patients too sedated to breathe on their own, then ordered unneeded tracheotomies for them -- enabling the for-profit hospital to reap revenue of as much as $160,000 per case.

You've got to be farking kidding me.

FTFA: : The physician could bill $160 each time he visited a tracheotomy patient at the hospital, versus $32 for seeing a ventilator patient in a nursing home.

Which is Medicare in a nutshell.

The infection risk for tracheotomies is higher, so they probably want to incentivize them being checked regularly.

But yeah, there are some weird Medicare reimbursements that really skew what doctors are willing to do. If the best procedure for a condition just barely brings in enough money to cover OR costs and staff, so the surgeon has to donate their time, no one is going to build a practice doing that.

I think most surgeons are doing just fine... I know they have a *lot* of advanced training and don't actually get close to these levels until at least middle-aged (it takes a lot of time to get to this point), but it's not exactly like these folks are barely getting by...

hardinparamedic:FTFA: Tracheotomies are typically used to open an air passage directly to the windpipe for patients who can't breathe otherwise.

Tracheotomies are common in patients who cannot be weened from the ventilator, or who will require long-term intubation and airway support. Not trying to argue with what the article says, but that's rather misleading of a statement.

FTFA: Based in part on surreptitious tape recordings, an FBI affidavit lays out allegations that a Sacred Heart pulmonologist kept patients too sedated to breathe on their own, then ordered unneeded tracheotomies for them -- enabling the for-profit hospital to reap revenue of as much as $160,000 per case.

You've got to be farking kidding me.

FTFA: : The physician could bill $160 each time he visited a tracheotomy patient at the hospital, versus $32 for seeing a ventilator patient in a nursing home.

Katolu:I'd rather have YOU treating me, hardin, than any of these "doctors"

To be fair, in an acute/critical care setting, sedating people on vents is pretty common. It improves lung compliance and oxygenation, and they don't try to fight the ventilator and end up with a bleb or a pneumo.

But there's a difference between knocking someone silly for a legitimate medical reason, and doping them up so they fail ventilator weening tests and traching them because of it.

WxGuy1:Skirl Hutsenreiter: hardinparamedic: FTFA: Tracheotomies are typically used to open an air passage directly to the windpipe for patients who can't breathe otherwise.

Tracheotomies are common in patients who cannot be weened from the ventilator, or who will require long-term intubation and airway support. Not trying to argue with what the article says, but that's rather misleading of a statement.

FTFA: Based in part on surreptitious tape recordings, an FBI affidavit lays out allegations that a Sacred Heart pulmonologist kept patients too sedated to breathe on their own, then ordered unneeded tracheotomies for them -- enabling the for-profit hospital to reap revenue of as much as $160,000 per case.

You've got to be farking kidding me.

FTFA: : The physician could bill $160 each time he visited a tracheotomy patient at the hospital, versus $32 for seeing a ventilator patient in a nursing home.

Which is Medicare in a nutshell.

The infection risk for tracheotomies is higher, so they probably want to incentivize them being checked regularly.

But yeah, there are some weird Medicare reimbursements that really skew what doctors are willing to do. If the best procedure for a condition just barely brings in enough money to cover OR costs and staff, so the surgeon has to donate their time, no one is going to build a practice doing that.

I think most surgeons are doing just fine... I know they have a *lot* of advanced training and don't actually get close to these levels until at least middle-aged (it takes a lot of time to get to this point), but it's not exactly like these folks are barely getting by...

Those salaries only work because their practice or hospital makes enough to pay them. If those surgeons only did cases that just paid for their PA, nurses, and OR costs, there wouldn't be money for their salaries.

Skirl Hutsenreiter:Those salaries only work because their practice or hospital makes enough to pay them. If those surgeons only did cases that just paid for their PA, nurses, and OR costs, there wouldn't be money for their salaries.

In addition to this, Vascular and Trauma surgery are very specialized medical pathways. A vascular surgeon's fellowship can last over 6 years, and Trauma Surgeons are almost exclusively employed by Level I and II Trauma Center Hospitals.

Incontinent_dog_and_monkey_rodeo:The worst thing is the fact that hospitals get paid more for making mistakes than they do for doing the job right. Any complications from surgery earn the hospital more than 3x what the surgery itself can be billed for. So there is a huge incentive to have to do repeat surgeries to fix "mistakes".

Actually, most of the time, they don't get any additional money for the complications, at least not from Medicare A, which operates on a PPS for hospital billing. Essentially, the hospital gets a flat rate based on how sick you were, not based on what they did. If they do badly and you get worse, they have to eat the additional cost. (They also are liable for the cost of preventable readmissions).

Gyrfalcon:cyberspacedout: All this and they're only investigating fraud? Killing patients is just a tad more serious, no?

Hard to prove someone sick enough to need that kind of intervention in the first place died from intentional homicide.

Although I've no doubt there is a concurrent investigation ongoing for criminal negligence and/or malpractice.

The article makes it clear that the intervention wasn't needed.

Call it involuntary manslaughter, then. If a patient dies as a result of unnecessary surgery or other unnecessary medical treatment, they can't just chalk it up to "shiat happens." I would assume that in this case the doctor was well aware that what he was doing was harmful to the patient as well.

I moved up here to Canada recently, and I've had to explain this numerous times. It's just easier to say, "The US Government is a wholly owned subsidiary of big business, including the medical industry. The entire function of the populace is to produce profit, which is then used to bribe lawmakers. Yeah, we know it sucks, but no one there is willing to up their taxes by a red cent to pay for health care or other entitlements, so this is how it is. Also, Americans are farking crazy."

aevorea:And this is exactly why whenever I have to be hospitalized, I ensure that an intelligent family member or friend is present who can speak with the medical staff when I'm not able to. Yes, it might annoy the medical staff ("I have a degree and this person is challenging me?!") but it also ensures that I'm not receiving unnecessary care purely for billing purposes.

So how is your intelligent family member going to determine whether the anesthesiologist gave you too much or just enough sedative? It's already an art in some sense.

The problem is that a lot of medicine is rather arcane, as it should be, and most people are not capable of making informed decisions. Heck a doctor who specializes in endocrinology is no better than an average Schmoe in regards to, say, melanoma. A GP or an internist might have some inkling to a number of different conditions, but wouldn't have the depth to know how to deal with many of them in a specific case.

At the same time, failure to perform the right treatment means death to the patient. There's no simple solution to this.

Son of Thunder:My google-fu is failing me. Why is it called Sacred Heart if it's owned by a private corporation, not the Catholic Church? Did it used to be a Catholic outfit until Scrooge McDuck bought it, and they didn't bother to rename it Grand Nagus Zek Memorial Hospital? Did the owners give it a Catholicy name so the rubes would think it was Catholic? Any Chicagoan farkers know what the deal is here?

So you're saying that you believe the Catholic Church isn't for-profit?

Son of Thunder:My google-fu is failing me. Why is it called Sacred Heart if it's owned by a private corporation, not the Catholic Church? Did it used to be a Catholic outfit until Scrooge McDuck bought it, and they didn't bother to rename it Grand Nagus Zek Memorial Hospital? Did the owners give it a Catholicy name so the rubes would think it was Catholic? Any Chicagoan farkers know what the deal is here?

I'll wager it was "owned" by nuns (Really owned by the nuns. Though the diocese, or Rome, would have to approve the sale.) until the corporation bought it. St. Elizabeth hospital in Appleton was run by the sisters for a long time. When it was sold to MHC (Ministry Health Care) Rome had to approve the sale. Why Rome? Because two different diocese corporations were involved was the given explanation.

/friend used to contract for MHC//apparently nuns ran a LOT of hospitals

Son of Thunder:Why is it called Sacred Heart if it's owned by a private corporation,

An attempt at deception really. By calling it Sacred Heart people will assume it has a religious affiliation, which in a city with as many Catholics as Chicago has is a big deal. Not just for Catholics but even non-Catholics would rather go to a Catholic affiliated hospital than some for profit run by who knows who. Until the current CEO stepped in it was Franklin Boulevard Community Hospital, he changed the name basically to dupe people.

Skirl Hutsenreiter:But yeah, there are some weird Medicare reimbursements that really skew what doctors are willing to do. If the best procedure for a condition just barely brings in enough money to cover OR costs and staff, so the surgeon has to donate their time, no one is going to build a practice doing that.

Here is a real-world example: an orthopaedic surgeon could inject a knee joint with corticosteroid or hyaluronic acid, and receive reimbursement for the injection.

He can use an ultrasound machine to assist with placement of the injection, for which he can collect additional revenue.

Is the ultrasound necessary? Maybe for somebody who is not experienced with joint injections, and would benefit from being able to visualize the joint line and the needle as it is inserted, and confirm distension of the joint upon injection. Maybe for a joint that is difficult to access - a thumb CMC joint, or shoulder, or whatever. But a knee injection is pretty easy to do, unless the patient is incredibly obese, or the joint is very deformed.

Does an experienced orthopaedic surgeon need an ultrasound to help him inject a knee? Not really, he's done it blindly hundreds of times already. Is it detrimental? Not from a medical standpoint - the ultrasound is non-invasive, and adds no significant risk. So the only potential harm is the added expense.

But who is able to distinguish between someone who would benefit from using the imaging modality, and someone who doesn't really need to use it, but likes pocketing a little extra reimbursement? Does this constitute fraud? Because one could easily justify to an auditor that the ultrasound maybe isn't totally necessary, but improves the chances of a successful joint injection from 99.5% to 100%. And we just want to do what's best for the patient, right?

hardinparamedic:Trauma Surgeons are almost exclusively employed by Level I and II Trauma Center Hospitals.

And it is very hard to get into, at least some years back I remember reading that trauma surgery was the most difficult training to get into. I know here in Chicago at Stroger Hospital, which was Cook County Hospital, they get who knows how many applications for a few slots each year, like four or five slots. Granted it has the historical cachet of being one of the hospitals where trauma surgery came into being and the docs there now were trained either by those who did that or by doctors they trained.

dericwater:The problem is that a lot of medicine is rather arcane, as it should be, and most people are not capable of making informed decisions. Heck a doctor who specializes in endocrinology is no better than an average Schmoe in regards to, say, melanoma. A GP or an internist might have some inkling to a number of different conditions, but wouldn't have the depth to know how to deal with many of them in a specific case.

We patients can't make decisions about the details of how a particular treatment is done, but if a doctor or surgeon can't give us the information we need to decide whether a particular treatment is done, the s/he should not be contemplating doing that treatment or, possibly, working in medicine.

It's not a chess game played for abstract intellectual entertainment. It affects real people's lives, and unless you are capable of explaining to real people how your actions might affect their lives and respecting their decision, you have no damn business in the medical profession.

I accompanied a relative to a neurosurgery assessment recently. In that case the situation was well explained: "There is an 80% chance that this surgery will help you, a 10% chance that it will have no effect and a 10% chance that things will get worse. It is possible that your condition will improve, so I recommend waiting a couple of months before deciding. If you want tp go ahead now, though, I will operate as soon as possible." We didn't need precise details of the surgery in question, but what we did want to know was given to us.

It's a bit like visiting a garage. You don't need to know what precisely they propose to do to your gearbox, but you do want information along the lines of "We can patch this one up for £500 and it should be good for 20,000 miles or we can put a new one in for £2,000 which should do you for the life of the car. Which looks like being another five years or so."

hardinparamedic:Katolu: I'd rather have YOU treating me, hardin, than any of these "doctors"

To be fair, in an acute/critical care setting, sedating people on vents is pretty common. It improves lung compliance and oxygenation, and they don't try to fight the ventilator and end up with a bleb or a pneumo.

But there's a difference between knocking someone silly for a legitimate medical reason, and doping them up so they fail ventilator weening tests and traching them because of it.

perhaps I missed something in TFA, but I saw no mention of a Vent in between breathing on their own and trach. Only that drugs were involved to put them in that state so that a trach was necessary.

cyberspacedout:Gyrfalcon: cyberspacedout: All this and they're only investigating fraud? Killing patients is just a tad more serious, no?

Hard to prove someone sick enough to need that kind of intervention in the first place died from intentional homicide.

Although I've no doubt there is a concurrent investigation ongoing for criminal negligence and/or malpractice.

The article makes it clear that the intervention wasn't needed.

Call it involuntary manslaughter, then. If a patient dies as a result of unnecessary surgery or other unnecessary medical treatment, they can't just chalk it up to "shiat happens." I would assume that in this case the doctor was well aware that what he was doing was harmful to the patient as well.

orbister:dericwater: The problem is that a lot of medicine is rather arcane, as it should be, and most people are not capable of making informed decisions. Heck a doctor who specializes in endocrinology is no better than an average Schmoe in regards to, say, melanoma. A GP or an internist might have some inkling to a number of different conditions, but wouldn't have the depth to know how to deal with many of them in a specific case.

We patients can't make decisions about the details of how a particular treatment is done, but if a doctor or surgeon can't give us the information we need to decide whether a particular treatment is done, the s/he should not be contemplating doing that treatment or, possibly, working in medicine.

It's not a chess game played for abstract intellectual entertainment. It affects real people's lives, and unless you are capable of explaining to real people how your actions might affect their lives and respecting their decision, you have no damn business in the medical profession.

I accompanied a relative to a neurosurgery assessment recently. In that case the situation was well explained: "There is an 80% chance that this surgery will help you, a 10% chance that it will have no effect and a 10% chance that things will get worse. It is possible that your condition will improve, so I recommend waiting a couple of months before deciding. If you want tp go ahead now, though, I will operate as soon as possible." We didn't need precise details of the surgery in question, but what we did want to know was given to us.

It's a bit like visiting a garage. You don't need to know what precisely they propose to do to your gearbox, but you do want information along the lines of "We can patch this one up for £500 and it should be good for 20,000 miles or we can put a new one in for £2,000 which should do you for the life of the car. Which looks like being another five years or so."

/my relative chose the operation/was in the last (bad) 10%/bugger

And how did they come up with the 80-10-10 probabilities? They could have pulled those out of their asses for all you know. Maybe in your relative's case, the real odds were 40-30-30, but by getting you to agree to doing the procedure, they earned more bucks.

The auto-repair analogy is quite apt. Especially when you don't get to see them doing the job (in the medical case, you're under anesthesia, and friends and family might watch from 20 feet away, not knowing what's occurring). Bottom line is you just don't know.